Wednesday, February 03, 2010

Legal Breakthrough for Sex Reassignment Surgery

From the New York Times:

BOSTON (AP) -- A woman who battled the IRS over a tax deduction for the costs of her sex-change operation says she feels like she won a victory for all transgender people.

Rhiannon O'Donnabhain (oh-DON'-oh-vin), who was born a man, sued the Internal Revenue Service in 2007 after the agency rejected a $5,000 deduction for about $25,000 in medical expenses associated with the sex-change surgery, finding it was a cosmetic procedure and not medically necessary.

On Tuesday, the U.S. Tax Court ruled that O'Donnabhain should be allowed to deduct the costs of her treatment for gender-identity disorder, including sex-reassignment surgery and hormone treatments.

''The tax court has spoken for my community and has supported my community by saying that this is a proper medical deduction, much the same as an appendectomy or open heart surgery,'' O'Donnabhain said in an interview Wednesday. Woman Says Sex-Change Tax Battle Also Helps Others

Skipping a little ways ...

''I think it's an important decision that could help educate and bring along transgender rights in other areas because it ratifies what the medical community has said clearly for years, which is for people with gender identity disorder, this type of surgery is frequently a medical necessity for their lives and for their health and for their well-being,'' said Hayley Gorenberg, deputy legal director at Lambda Legal.

The Tax Court voted 11-5 to grant the deduction.

In a dissenting opinion, Judge David Gustafson said he believes sex reassignment surgery falls within the ''cosmetic surgery'' category of the tax code and the expense is therefore not deductible.

Even if such surgery ''is medically indicated ... it is an otherwise cosmetic procedure that does not 'treat' the mental disease,'' Gustafson wrote.

Ha, but it does "'treat' the mental disease!" Preliminarily, a person feels that their true sex differs from that indicated by their physical body. Subsequently, they feel that their true sex corresponds to their physical body. Voila: 'treated.'

O'Donnabhain said she underwent sex-reassignment surgery at age 57, after a tormented existence as a father, husband, Coast Guardsman and construction worker.

An estimated 1,600 to 2,000 people a year undergo sex-change surgery in the United States, according to the Gay and Lesbian Medical Association.

Once again bad anonymous makes up a false claim despite total ignorance of reality. Fact is that there is all manner of proof that gender reassignment surgery resolves transexuals anxiety of their bodies. Recent studies show a 100%satisfaction rate.

The most comprehensive study of post-SRS outcomes is “Sex Reassignment. Thirty Years of International Follow-up Studies” by Friedemann Pf’fflin and Astrid Junge (1992 in German, English translation 1998). Pf’fflin and Junge used data from over 70 studies, in total considering the outcomes of over 2000 patients from 13 countries. They found that outcomes - measured in terms of “subjective satisfaction; mental stability; socioeconomic functioning; and partnership and sexual experience” - of SRS are generally positive. Overall, 71% of male-to-female (MTF) and 90% of female-to-male (FTM) operations had positive results. When they limited their sample only to more recent patients (who benefited from improvements in techniques and procedures over the decades), the results were positive for 87% of MTFs and 97% for FTMs.

That study is now over 10 years old and two more recent studies have shown 100% satisfaction rates:

http://www.springerlink.com/content/p005571hmv827611/Jamil Rehman, Simcha Lazer, Alexandru E. Benet, Leah C. Schaefer and Arnold MelmanAbstract From 1980 to July 1997 sixty-one male-to-femalegender transformation surgeries were performed at ouruniversity center by one author (A.M.). Data werecollected from patients who had surgery up to 1994 (n = 47) to obtain a minimum follow-up of 3years; 28 patients were contacted. A mail questionnairewas supplemented by personal interviews with 11 patientsand telephone interviews with remaining patients to obtain and clarify additional information.Physical and functional results of surgery were judgedto be good, with few patients requiring additionalcorrective surgery. General satisfaction was expressed over the quality of cosmetic (normal appearinggenitalia) and functional (ability to perceive orgasm)results. Follow-up showed satisfied who believed theyhad normal appearing genitalia and the ability to experience orgasm. Most patients were ableto return to their jobs and live a more satisfactorysocial and personal life. One significant outcome wasthe importance of proper preparation of patients for surgeryand especially the need foradditional postoperative psychotherapy. None of thepatients regretted having had surgery. However, somewere, to a degree, disappointed because of difficultiesexperienced postoperativelyin adjusting satisfactorilyaswomen both in their relationships with men and in livingtheir lives generally as women. Findings of this studymake a strong case for making a change in the Harry Benjamin Standards of Care to include aperiod of postoperative psychotherapy.

http://www.springerlink.com/content/g40k461746677054/Anne A. LawrenceAbstract This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique. Participants, all of whom were at least 1-year postoperative, completed a written questionnaire concerning their experiences and attitudes. Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. Most indicators of transsexual typology, such as age at surgery, previous marriage or parenthood, and sexual orientation, were not significantly associated with subjective outcomes. Compliance with minimum eligibility requirements for SRS specified by the Harry Benjamin International Gender Dysphoria Association was not associated with more favorable subjective outcomes. The physical results of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting postoperative satisfaction or regret.

http://www.springerlink.com/content/p4347n067550n604/

Abstract The dearth of information regarding orgasm in postoperative transsexuals prompted the authors to study its prevalence. The sample consisted of 14 male-to-female (M—F) and 9 female-to-male (F—M) postoperative transsexuals. The relationship of orgasm to sexual and general satisfaction was explored via a specially designed questionnaire. Orgastic capacity declined in the M—F group and increased in the (F—M) group. Despite the decrease in orgasm in the M—F group, satisfaction with sex and general satisfaction with the results of surgery were high in both groups. General satisfaction of 86% replicates other studies. Frequency of sex increased by 75% in the M—F group and by 100% in the F—M group. A phalloplasty does not appear to be a critical factor in orgasm or in sexual satisfaction. The general conclusion is reached that it is possible to change one's body image and sexual identity and be sexually satisfied despite inadequate sexual functioning.

In order to have gender reassignment surgery/hormones qualify for a deductible medical expense (but not breast augmentation), gender identity disorder is legally a treatable disease. This tax ruling does not say that the disease can be cured, and hormones/reassignment surgery is the only or right treatment. If gender identity is a treatable disease then it can be prevented.How do you feel about this?

Wrong again Anonymous. Transgender, is not a mental illness....It was listed as such due to the medical establishment did not know where to list it for treatment purposes... Their is no treatment for this to prevent it, because it is a birth defect not a mental illness. A child born with a cleft pallett is not treated for an illness, but people like you want to list us as being mentally ill because we are born with physical deformities, that make our bodies the oposite of what it should be.. the medical establishment have diagnosed this completely wrong...But it was diagnosed this way so that the transsexual could be treated and so the medical industry could have a place for it in their own system. Narrow minds and a large majority of the medical industry have ignored these findings.WHY? Because if it is listed as a birth defect as it should be listed, then we would no longer have a need for psychologist or the psychiatric industry taking a major amount of finance away from them. To the medical indusrty a Birth Defect is a psyical condition that in some cases is curable through surgery or prostetics.HMMMMMM kinda sounds like what they do for the transsexual community.... Now lets look at the medical cost and where it comes from.... Psychiatric care is a very costly and money making indusrty, so a transsexual goes to see a Psych... But if they cannot afford to see one then the State or provence picks up the charge....So in order to keep this lucrative source of income comming in the Psychiatric industry has fought tooth and nail to keep it listed as it is with the help of the medical industry... Psychiatrists have feed faulse information about the transsexual to the medical industry so they could keep it listed as a mental illness, which if taken off this list would result in a loss of fiance for them.... When it is all said and done, it comes down to the greed for money from one part of the medical industry If a patient cannot afford the cost of the treatment, then the taxpayers pay for it over the coruse of the transsexuals lives or till surgery is completed and they are no longer needed... If socity were to see this then they would know that this is just one more way that the medical establishment has been useing to milk the public out of more money....Long term Psychiatric care is a high dollar industry...When look at in perspecive to the cost of a one time surgery that yes could cost into the hundreds of thousands of dollars, versus the continual cost of care which leads into the millions of dollars. Then why would you list this as anything else....